Potential adverse effects of antipsychotics during pregnancy: A narrative review with a focus on metabolic alterations.

Antipsychotics are psychotropic drugs used to treat psychosis in psychotic disorders, including schizophrenia and bipolar disorders. This family of drugs is composed of heterogenous members with complex and distinct pharmacological profiles. The main mechanism of action is inhibition of dopamine signaling through the D2 receptor, and some antipsychotics also inhibit serotonin signaling through 5-HT2A/C receptors. However, several members of this family act on other receptors, including histamine and α-adrenergic receptors. The combination of all these activities leads to central and systemic adverse effects that complicate treatment. Notably, it is increasingly recognized that many antipsychotics lead to metabolic derangements produced by direct and indirect activities. In this review, we focus on metabolic adverse effects of commonly used antipsychotics, and their potential adverse effects on the developing fetus when used during pregnancy. Since current guidelines do not recommend discontinuation of treatment during pregnancy, adverse effects on fetal development could be a relevant issue for the management of psychosis in pregnant women.